Gitte Pedersen

Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and transmission. This is suggested to be due to higher HIV RNA levels in cervicovaginal fluids in women living with HIV (WLWH) with BV, as bacteria associated with BV may induce viral replication and shedding in the genital tract despite undetectable HIV RNA plasma viral load. We examined the prevalence and diagnostic predictors of BV and HIV-1 RNA vaginal shedding in women living with HIV (WLWH) in Denmark, taking into account the presence of human papillomavirus (HPV) and herpes viridae. WLWH between 18–51 years were recruited from six Departments of Infectious Diseases in Denmark during enrolment in the SHADE cohort; a prospective cohort study of WLWH attending regular outpatient care. BV was diagnosed by microscopy of vaginal swabs and PCR was used for detection of BV-associated bacteria, HPV, herpes viridae, and vaginal HIV viral load. Median age of the 150 included women was 41 years; ethnicity was predominantly White (35%) or Black (47%). The majority (96%) was on ART and had undetectable (85%) plasma HIV RNA (<40 copies/mL). BV was diagnosed in 32%. Overall, 11% had detectable vaginal HIV RNA. Both before and after adjustment for BV, age, ethnicity, plasma HIV RNA, CD4 cell count, herpes viridae and HPV, we found no significant predictors of HIV RNA vaginal shedding. In well-treated WLWH, BV, herpes viridae or HPV do not predict vaginal HIV RNA shedding. This implies that HIV shedding does not seem to be increased by BV.

HIV patients are known to be at increased risk of lung cancer but the risk factors behind this are unclear.

Larsen IK, Pedersen G, Schønheyder HC. Bacteraemia with an unknown focus: is the focus de facto absent or merely unreported? A one‐year hospital‐based cohort study. APMIS 2011; 119: 275–9.An unknown focus of infection is associated with an increased risk of death in patients with bacteraemia. However, the implications for patient management remain uncertain, and to our knowledge, the validity of an unknown focus has not been evaluated. Therefore, we conducted a retrospective record review of bacteraemias with an unknown focus recorded in a regional bacteraemia database. The study cohort comprised 645 cases of bacteraemia diagnosed in 537 hospitalized patients at Aalborg Hospital, Denmark, in 2003. The focus was unknown in 184 (29%) bacteraemia episodes (162 patients). The record review pointed conclusively to a focus in 39 episodes. The positive predictive value of an unknown focus was 79% and the proportion of bacteraemias with a focus increased from 71% to 78%. Among the 145 cases of bacteraemia with a de facto unknown focus, there were 36 incidents of febrile neutropenia and 20 additional incidents of early death which precluded a search for a focus. The study confirmed the focus to be de facto absent in most patients classified with an unknown focus. The distribution of foci changed only marginally by the disclosure of a focus in one of five patients in the ‘unknown’ group.

The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART.